ASA President Dr. Linda Mason: Hold insurers accountable for surprise medical bills

Surprise medical billing continues to devastate both patients and providers as unsuspecting patients see their medical bills skyrocket, while providers continue to be handcuffed when it comes to combating surprise bills.

Linda Mason, MD, president of the American Society of Anesthesiologists, laid out the organization's viewpoints on surprise medical billing-related legislation and shared how anesthesiologists can get involved in the issue.

Note: Responses were edited for style and clarity.

Question: If it was up to ASA, how would the government fix the surprise billing problem?

Dr. Linda Mason: The American Society of Anesthesiologists agrees that surprise medical bills are wrong for patients. Congress needs to fix the issue, but it needs to be done the right way. ASA endorsed the comprehensive bipartisan proposal "Protecting People from Surprise Medical Bills Act," HR 3502, written by Reps. Raul Ruiz, MD, D-Calif., and Phil Roe, MD, R-Tenn., with more than 70 additional co-sponsors.

HB 3502 is a fair proposal that puts patients first by holding them harmless from unanticipated bills. It doesn't pick winners or losers but instead places the dispute where it should be — between the healthcare provider and the insurance company. It also helps patients by providing greater transparency of their in-network providers while ensuring an independent dispute resolution system to resolve billing disputes.

Q: What's stopping the government from addressing surprise billing now?

LM: There is agreement among all stakeholders that surprise medical bills should be banned. However, there are significant disagreements on how to ensure an appropriate payment to those who actually provide the care. Physician anesthesiologists do not typically know the insurance status of their patients. They don't know if the patient is in network or out of network.

The anesthesiologist safely provides anesthesia or pain medicine service with the expectation that an appropriate payment will be forthcoming from the insurer. ASA and other medical specialty organizations are advocating for maintaining balance between actual healthcare providers and insurers by preserving negotiated payment levels.

In contrast, health insurance companies are looking at this as an opportunity to strengthen their leverage over physicians' practices. They are advocating for a new federal law that would implement rate-setting in the commercial insurance marketplace. Legislation mandating rate-setting authored by [Reps.] Frank Pallone, D-N.J., and Greg Walden, R-Ore., HR 3630, is going to hurt local physician practices and limit patients' access to high-quality physicians. Meanwhile, similarly concerning legislation, SB 1895, is being considered in the Senate.

These are the wrong solutions for patients; if the insurer can pay the same rate to all out-of-network physicians, there is absolutely no motivating factor to entice them into negotiations with physicians to develop robust networks for patients. These bad bills will empower insurance companies to use their large size and dominance to harm local physician practices. ASA believes a more balanced approach is necessary to fairly resolve this issue.

Q: Are there any states that have been successful in combating surprise medical billing? What sort of trends can the government take from them?

LM: Actually, HB 3502 written by Reps. Ruiz and Roe is based on the successful New York state model — a model with robust patient protections that removes patients from billing disputes and holds them harmless from surprise medical bills. The New York state model has been in place since 2015 and has reduced complaints related to surprise bills while also saving health care dollars. The legislation does not pick physicians or health insurance companies as winners or losers, it creates a mechanism for the two sides to fairly resolve their payment disputes. In fact, in [New York], the law is operating in such a way that encourages negotiation between the two sides, enabling a resolution before an independent dispute resolution entity is even necessary.

Q: Is there anything individual anesthesiologists can do in support of ending surprise medical billing?

LM: Absolutely. I would encourage every anesthesiologist to contact their policymaker — either call them or send an email. Request a meeting to explain the issue, write a letter to the editor in your local paper, and post or tweet about the issue on your social media channels.

It is critical that anesthesiologists help policymakers understand the complete picture on surprise medical bills. We support banning surprise medical bills through legislation that treats all stakeholders fairly. Most solutions are focused on policies to address physician behavior. That approach is ill-advised and represents poor public policymaking. The vast majority of anesthesiologists' claims are in network — over 90 percent, according to the Health Care Cost Institute.

Physicians did not create the idea of "narrow networks," and state legislatures didn't pass network adequacy laws because there were too many physicians in the insurance plan's network. Just last year, the Texas Department of Insurance fined a health insurance company $700,000 for lacking adequate anesthesiologists in their networks. Insurers need to be held accountable for their business models.

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